Taking a Look at Left Atrial Appendage

This case study discusses the management of a 68 year old male who presented with chest palpitations secondary to rapid atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia with serious complications if not treated correctly. This essay will discuss the initial clinical presentation of the patient and examine the management and outcome of the interventions applied. The significance of atrial fibrillation including its pathophysiology and aetiology will also be discussed.

We’ve all heard of open heart surgery, but not all of us know exactly what it is, which is why I’m here to explain it. To start it off, heart surgery, according to MedlinePlus, “is any surgery done on the heart muscle, valves, arteries, or the aorta and other large arteries connected to the heart.” However, there is also open heart surgery, which although sounds the same there are quite some differences, for when doing open heart surgery, you’re going to have to be connected to a bypass machine during surgery, for your heart has been stopped because of it. Other than stopping your heart, the bypass machine is able to give you the necessary oxygen that your blood needs, move that blood throughout your whole body, and get rid of carbon dioxide.

The flow of blood through the heart is controlled by four valves. If any are not working correctly, blood cannot flow or be pumped effectively to the heart. The four valves are: the tricuspid, pulmonary semilunar, mitral, and aortic semilunar. There are many abnormalities or defects that can affect their operation and in this paper, I will discuss the most common one which is a “mitral valve prolapse.” A valvular prolapse is an abnormal protrusion of a heart valve that causes the valve to not close completely. It is also known as “click murmur syndrome” and “Barlow’s syndrome” and is more prevalent in women than men. It has a strong hereditary

At this point, we do not know exactly what are the settings, we have previous requested pacemaker operative report from Regions. Unfortunately, from what he is telling today, his date of the birth was not correct as such dose report were not same. He noted that he thinks he came back from the hospital, he has not had similar complaint or concern or report of chest pain. It should be noted that hospital records, with a troponin that was negative, 12-lead EKG was similar to the one that was obtained here, essentially identifying sinus bradycardia with first-degree AV block, left ventricular hypertrophy with repolarization abnormality. QT was prolonged, similar EKG obtained at facility also identified pretty much the same abnormality pattern. Troponin was negative. Other workup included chest x-ray in the hospital were all unremarkable. Today he is not reporting any chest pain, no shortness of breath, no nausea or emesis. He has got healed ____ scar to the left chest from pacemaker implantation which is completely healed but slightly

One of the complications of an acute MI is Left Ventricular Aneurysm (LVA) which is a localized area of myocardium with abnormal outward bulging and deformation during systole and diastole. The epidemiology occurs in 10-30% of patients after an acute MI (American Heart Association 2015). The risk factors include total occlusion of the LAD artery, females and an anterior MI. To prevent this, early revascularization is needed. The LVAs usually range from 1-8 cm.

Mitral valve prolapse (MVP) was first characterized by Barlow and Bosman in the 1960s.(Barlow and Bosman) It was first called Barlow’s Syndrome before being called mitral valve prolapse by Criley (Barlow and Bosman),(Criley et al.). Barlow’s syndrome was diagnosed by electrocardiogram, phonocardiogram and chest X-ray.3 The mitral valve apparatus includes tow leaflets, chordae tendineae, anulus, left atrium, papillary muscles and left ventricular wall (Devereux et al.). Mitral valve prolapse involves the leaflets, chordae, annulus and left ventricular wall.(Devereux et al.) The anterior leaflet is relatively long and semi-circular, while the posterior leaflet is shorter in normal patients.(Irvine et al.) Most commonly the posterior leaflet is affected.(Devereux et al.) During systole the leaflet balloons in to the left ventricle.(Devereux et al.) Physically, in a patient with mitral valve prolapse, the leaflet is displaced beyond the mitral anulus.(Levine et al.)

Remaining details regarding the surgery will be presented by Dr. Mark Davidson (Cardiovascular surgeon) and DR. Peter Andrews.

There were a few places that had performed the Norwood operation, (at the time only ). It was a new procedure, and survival rates were not very promising. Two surgeons that had the best results in the U.S. along with a few skilled cardiologists had formed a clinic

The purpose of this paper is to analyze if there is any improvement, post-operative complications, mortality and related factors of elderly undergoing cardiac surgery. The debate whether or not we are pushing the limits is still questionable because of the complications associated with these invasive surgeries and whether or not if it’s a money game. The growing numbers of the elderly patients enjoy a prescription drug benefit, access to artificial knee and hip surgery, and life-saving cardiovascular interventions that were undreamed of a half-century ago.

Aortic stenosis is the most common valvular heart disease of the developed world. About 7% of the population over age 65 suffer from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is known to be dismal without valve replacement. Even though American College of Cardiology recommends aortic valve replacement as a class I recommendation to treat symptomatic severe aortic stenosis, approximately a third of these patients over the age of 75 are still not referred for surgery. Typically, this is due to concern about prohibitive surgical risk due to patient frailty, co-morbidities, age, and severe left ventricular dysfunction. The advent of transcatheter aortic valve replacement (TAVR) in Europe raised the hope for an alternative, less invasive treatment for aortic stenosis in the United States. We present a review of the existing and emerging literature pertaining to TAVR, including the PARTNER (Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve) and CoreValve trials. Although surgical valve replacement (SAVR) remains the modality of choice for patients with severe aortic stenosis and low to intermediate operative risk for now, TAVR has certainly become the preferred approach for high risk patients, and it may gain traction for low and intermediate

After years of what sometimes seemed painstaking slow efforts to bring a less invasive approach to managing mitral valve (MV) disease, things are finally moving forward on several fronts. It 's likely a response to the eye-opening clinical success and rapid adoption of transcatheter aortic valve replacement (TAVR). The success of TAVR has reinvigorated efforts to develop less invasive approaches to the other heart valves. It has not been easy, but the transcatheter revolution marches on.

The ideal prosthetic valve that combines excellent hemodynamic performance and long-term durability without increased thromboembolic risk or the need for long-term anticoagulation does not exist. Choice of operation and the prosthesis used for those patients undergoing valve replacement is important for each individual patient and ideally should be made together by the patient, cardiologist, and surgeon.

The results are in line with the studies included in the analysis except Erlebach who reported higher mortality with ViV-TAVI at 1 year. Erlebach et al attributed this increase in mortality to the unequal distribution of baseline comorbidities between the two groups in their study. 8 Majority of the patients who underwent ViV-TAVI in their study had SVD secondary to stenosis (46%). Studies have shown that mortality tended to be higher in patients receiving ViV-TAVI secondary to BP valve stenosis. 23 This could be due to life threatening procedural complications like ostial main obstruction, increased valvular gradients from reduced area available for the implanted valve or patient prosthetic mismatch. 23 ViV-TAVI was associated with lower risk of PPM implantation compared to redo-SAVR (OR: 0.43, CI: 0.21 to 0.89; p= 0.02). The redo-SAVR requires extensive debridement of the ventricular septum which might damage the conduction system of the heart. 6 Whereas during ViV-TAVI, the failed bioprosthesis protects the conduction system from injury. 24 Some studies reported that incidence of AKI with redo- SAVR was higher and could be due to protracted operative time and longer duration of cardiopulmonary bypass in patients undergoing redo-SAVR, however we observed no

Callejja et al (2010) reported on a case-control study of 30 patients with severe aortic stenosis undergoing noncardiac surgery between 1998 and 2007 at Mayo clinic Scottsdale campus. There were no death in aortic stenosis group and only one death in controlled group. The composite end point (death and major cardiac adverse event) was more frequent in aortic stenosis patient (33% vs 23%), but the difference was not statistically significant (p=0.06). The study suggested that asymptomatic severe aortic stenosis patient can undergo moderate-risk, noncaridac surgery without major cardiac events.

Initial electrocardiogram (EKG) revealed normal sinus rhythm with non-specific T wave abnormalities in the lateral leads. Serial troponin I were 7.050, 10.9, 29.7 consistent with Non-ST segment Myocardial Infarction (NSTEMI) and coronary angiography was planned. An FL4 (Boston Scientific) catheter was used to engage the left coronary artery, which demonstrated a patent Left main (L) giving rise to the Left anterior descending(L) and ramus arteries, both with minimal disease. An FR4(Boston Scientific) catheter was used to engage the Right coronary artery RCA which gave rise to the posterior descending artery (PDA) and posterolateral branches (PLB), all with minimal disease. Surprisingly, the Left circumflex artery LCx was found to originate from the proximal RCA and was totally occluded at its proximal segment. We used a multipurpose catheter to engage the RCA . Subsequently, the LCx lesion was crossed with a Whisper wire and a Runthrough wire(Terumo) in a buddy-technique was utilized to provide additional support. A 2.0 x 12 mm Emerge balloon was used to dilate the proximal LCx and the mid-LCx lesion. This was followed by the deployment of a 2.5 x 32 mm Promus Premier Stent (Boston Scientific) to the proximal left circumflex